Trochanter attachment device

ABSTRACT

A trochanter attachment device can include a plate for attachment to an inner portion of a greater trochanter of a femur, a collar for attaching the plate to a hip implant, and a fastener for securing the collar to a hip implant. The trochanter attachment device can include a groove or other feature for receiving a reinforcing material, such as a wire or a cable, such as to reinforce an attachment of the device to the greater trochanter and/or the hip implant. The trochanter attachment device can include an insert attachable to the plate and configured to attach the plate to the greater trochanter. All or a portion of the plate and/or the insert can include a porous material, such as to promote bone ingrowth of the greater trochanter.

CLAIM OF PRIORITY

This application is a continuation of U.S. patent application Ser. No.13/970,073, filed on Aug. 19, 2013, which application claims the benefitof priority of U.S. Provisional Application Ser. No. 61/684,898, filedon Aug. 20, 2012, which applications are incorporated by referenceherein in their entirety.

TECHNICAL FIELD

The present patent application relates to orthopedic implants, and moreparticularly, to an apparatus and method for reattaching the greatertrochanter to the femur during or following hip arthroplasty.

BACKGROUND

Orthopedic procedures may be used for the replacement of all, or aportion of, a patient's joint. Total hip arthroplasty may be used torestore function to a diseased or injured hip joint. The hip joint is aball and socket joint that includes the acetabulum and the femoral headof the femur (or femoral bone). The femur also includes the greatertrochanter.

As part of the original hip arthroplasty or a later hip revisionsurgery, all or a portion of the greater trochanter may become detachedfrom the femur. Existing techniques for reattaching the greatertrochanter to the femur can include attaching a metal plate to an outerportion (a lateral side) of the greater trochanter such that the metalplate extends lengthwise down the outer side of the femur. This type ofplate may be used with wires or cables that wrap around the greatertrochanter and the femur.

OVERVIEW

The present inventors have recognized, among other things, that there isan opportunity for a trochanter attachment device that can providegreater stability to the greater trochanter, such as relative to thefemur and a femoral component of a hip implant. More particularly, thepresent inventors have recognized that a device can be secured to aninner portion (a medial side) of the greater trochanter, as well as tothe hip implant, such as to help provide stability to the greatertrochanter. The trochanter attachment device described herein can beused, for example, in cases where the greater trochanter is deficient(for example, having cracks and/or missing portions) and/or partially orwholly detached from the femur.

To better illustrate the trochanter attachment device and methodsdisclosed herein, a non-limiting list of examples is provided here:

In Example 1, a trochanter attachment device comprises a plate, acollar, and a fastener. The plate can have an inner surface and an outersurface configured to attach to an inner portion of a greater trochanterof a femur. The collar can be attached to the inner surface of the plateand configured to connect the plate to a hip implant. The fastener canbe configured for securing the collar to the hip implant. A bottom endof the collar can be configured to contact a top surface of the hipimplant. An upper portion of the plate can be configured to extend abovethe top surface of the hip implant when the collar is secured to the hipimplant, and a lower portion of the plate can be configured to extendbelow the top surface of the hip implant when the collar is secured tothe hip implant.

In Example 2, the trochanter attachment device of Example 1 isoptionally configured such that the fastener includes a screw and a nutconfigured to engage with the screw and a stem of the hip implant.

In Example 3, the trochanter attachment device of Example 2 isoptionally configured such that the nut includes a first end portionhaving a threaded portion configured to engage with the screw and asecond end portion having a threaded portion configured to engage withthe stem of the hip implant.

In Example 4, the trochanter attachment device of any one of Examples 2or 3 is optionally configured such that the nut comprises a spline on anouter surface of the nut. The spline can be configured to engage with aninside surface of the collar.

In Example 5, the trochanter attachment device of Example 2 isoptionally configured such that the nut includes a first end portionconfigured to engage with the screw and a second end portion configuredto engage with the stem of the hip implant. The first end portion caninclude a cone-shaped portion configured to engage with an insidesurface of the collar.

In Example 6, the trochanter attachment device of any one of Examples1-5 optionally further includes an insert configured to be attachable tothe outer surface of the plate and configured to attach the plate to thegreater trochanter.

In Example 7, the trochanter attachment device of Example 6 isoptionally configured such that the insert includes a porous portion.

In Example 8, the trochanter attachment device of Example 7 isoptionally configured such that the porous portion includes tantalum.

In Example 9, the trochanter attachment device of any one of Examples1-8 optionally further includes a ring including a groove extending atleast partially circumferentially around an outer surface of the ring.The ring can be configured to be attachable to an outer surface of thecollar.

In Example 10, the trochanter attachment device of any one of Examples1-9 is optionally configured such that the collar includes a groove onan outer surface of the collar configured for receiving a reinforcingmaterial.

In Example 11, the trochanter attachment device of any one of Examples1-10 is optionally configured such that the fastener includes a screw.The screw can include a groove extending at least partiallycircumferentially around an outer surface of the screw.

In Example 12, the trochanter attachment device of any one of Examples1-11 is optionally configured such that the plate and the collar includeat least one of stainless steel, cobalt, cobalt-chromium, titanium,tantalum, or one or more alloys thereof.

In Example 13, the trochanter attachment device of any one of Examples1-12 is optionally configured such that the plate and the collar includea porous tantalum region.

In Example 14, the trochanter attachment device of any one of Examples1-14 is optionally configured such that the fastener secures the bottomend of the collar to a top surface of a femoral component of the hipimplant.

In Example 15, a trochanter attachment device comprises a plateconfigured to attach to an inner portion of a greater trochanter of afemur, a collar attached to the plate and configured to contact an outersurface of a hip implant to secure the plate to the hip implant, a screwconfigured to extend through the collar for securing the collar to thehip implant, and a nut having a first end portion and a second endportion. The first end portion of the nut can be configured to engagewith the collar and the screw. The second end portion of the nut can beconfigured to engage with a stem portion of the hip implant. The platecan include at least one aperture configured for receiving a fastenerconfigured to secure the plate to the greater trochanter.

In Example 16, the trochanter attachment device of Example 15 optionallyfurther includes an insert configured to be attachable to an outersurface of the plate and configured to attach the plate to the greatertrochanter. The insert can include a porous material.

In Example 17, the trochanter attachment device of Example 16 isoptionally configured such that the porous material includes tantalum.

In Example 18, the trochanter attachment device of any one of Examples15-17 is optionally configured such that the plate and the collarinclude at least one of stainless steel, cobalt, cobalt-chromium,titanium, tantalum, one or more alloys thereof, or one or morecombinations thereof.

In Example 19, the trochanter attachment device of any one of Examples15-18 is optionally configured such that the outer surface of the plateis configured to attach to an inside portion of the greater trochanter.

In Example 20, a method of securing a greater trochanter to a femurusing an attachment device comprising a plate and a collar includesattaching an outer surface of the plate to an inner portion of thegreater trochanter. The method further includes attaching the collar toa top surface of a hip implant implantable into the femur and securingthe attachment device to at least one of the greater trochanter and thehip implant. The attachment device can be configured such that, when thecollar is attached to the top surface of the hip implant, an upperportion of the plate extends above the top surface of the hip implantand a lower portion of the plate extends below the top surface of thehip implant.

In Example 21, the method of Example 20 is optionally configured suchthat securing the attachment device to at least one of the greatertrochanter and the hip implant includes using at least one reinforcingmaterial.

In Example 22, the method of Example 21 is optionally configured suchthat the at least one reinforcing material includes at least one of acable, a wire, a bolt, a suture, or one or more combinations thereof,and the attachment device includes at least one feature configured toreceive the at least one reinforcing material.

In Example 23, the method of any one of Examples 20-22 is optionallyconfigured such that attaching the outer surface of the plate to aninner portion of the greater trochanter includes placing an insertbetween the plate and the inner surface of the greater trochanter. Theinsert can include a porous material.

In Example 24, the device or method of any one or any combination ofExamples 1-23 is optionally configured such that all elements or optionsrecited are available to use or select from.

These and other examples and features of the present trochanterattachment devices and methods will be set forth in part in thefollowing Detailed Description. This overview is intended to provide asummary of subject matter of the present patent application. It is notintended to provide an exclusive or exhaustive explanation of theinvention. The detailed description is included to provide furtherinformation about the present patent application.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings, which are not necessarily drawn to scale, like numeralsmay describe similar components in different views. Like numerals havingdifferent letter suffixes may represent different instances of similarcomponents. The drawings illustrate generally, by way of example, butnot by way of limitation, various embodiments discussed in the presentdocument.

FIG. 1 is a perspective view of a pelvic bone and femur, the femurincluding a greater trochanter and a femoral head.

FIG. 2 is a perspective view of a hip prosthesis that may be used in ahip replacement surgery.

FIG. 3 is a perspective view of an example of a trochanter attachmentdevice in accordance with the present patent application.

FIG. 4 is an exploded perspective view of the trochanter attachmentdevice of FIG. 3.

FIG. 5 is a perspective view of the trochanter attachment device of FIG.3 attached to a proximal femoral component of a hip prosthesis.

FIG. 6 is a cross-sectional view of the trochanter attachment device andthe hip prosthesis of FIG. 5.

FIG. 7 is a perspective view of an example of a trochanter attachmentdevice in accordance with the present application.

FIG. 8 is an exploded perspective view of the trochanter attachmentdevice of FIG. 7.

FIG. 9 is a perspective view of the trochanter attachment device of FIG.7 attached to a hip prosthesis and to a greater trochanter.

FIG. 10 is a cross-sectional view of the trochanter attachment device,the hip prosthesis and the greater trochanter of FIG. 9.

FIG. 11 is an exploded perspective view of an example of a trochanterattachment device in accordance with the present patent application.

DETAILED DESCRIPTION

The present application relates to devices and methods for attaching orreattaching a greater trochanter of the femur to the femur, such asduring a hip arthroplasty and/or as part of a later hip revisionsurgery. FIG. 1 shows a femur or femoral bone 10 and a pelvic bone 12.As shown in FIG. 1, the femoral bone 10 has different bone regions,including a femoral head 14 and a greater trochanter 16. In hiparthroplasty, at least part of the hip joint is replaced with animplant, such as a prosthesis 50 shown in FIG. 2. The hip prosthesis orimplant 50 can include an acetabular shell 52, a femoral head 54, animplant body 56, and a stem 58. In some designs of the prosthesis orimplant 50, the implant body 56 can be attached to the stem 58, such asusing a nut and threads, taper or other means to engage and connect theimplant body 56 to the stem 58.

As part of the hip replacement surgery or arthroplasty, the femoral head14 can be removed from the femoral bone 10. An opening can be createdthrough the diaphysis of the femoral bone 10. Such an opening can followthe intramedullary canal of the femur and can be configured forreceiving the stem 58 of the implant 50. In some cases, the greatertrochanter 16 remains intact on the femoral bone 10; however, in someinstances, the greater trochanter 16 can become deficient, or partiallyor completely detached from the femoral bone 10. Even if the greatertrochanter 16 remains intact following the original replacement surgery,if a revision has to be performed, the greater trochanter 16 may likelybecome further compromised or detached as a result of the revisionsurgery.

FIG. 3 shows an example of a trochanter attachment device 100 that caninclude a plate 102, a collar 104, a screw 106, and a nut 108. Each ofthese components is also shown in FIG. 4, which is an exploded view ofthe trochanter attachment device 100 of FIG. 3. The trochanterattachment device 100 can be used during a hip replacement surgery orduring a revision surgery. The plate 102 is configured for attachment toan inner surface or inner portion of the greater trochanter 16. In anexample of the attachment device 100 shown in FIGS. 3 and 4, the plate102 can include one or more apertures 110, which can extend from aninner surface 112 of the plate 102 to an outer surface 114 of the plate102, and which can be configured to respectively receive a fastener,such as for securing the plate 102 to the greater trochanter 16. Knowntypes of fasteners or fixation devices, such as, for example, bonescrews, can be used with the apertures 110. The plate 102 can includemore or less apertures 110 compared to the two apertures 110 shown inFIGS. 3 and 4.

The collar 104 can be attached to the plate 102. The collar 104 can beconfigured to connect the plate 102 to a hip implant, such as shown inFIG. 5. The collar 104 can include an opening 116, which can extend froma first end 118 to a second end 120 of the collar 104. The opening 116can be configured to engage with the screw 106 and the nut 108. As shownin FIG. 4, the nut 108 can include one or preferably a plurality ofsplines 126, such as near a first end 122 of the nut 108. In an example,the first end 118 of the collar 104 can be configured to align with thefirst end 122 of the nut 108, such as to permit the one or more splines126 to contact an inner surface 128 of the collar 104. In an example,the collar 104, including the inner surface 128, can include or can beformed of a porous structure, such as to permit the splines 126 to gripthe porous material on the inner surface 128. As an alternative to or inaddition to the porous material, the inner surface 128 can includegrooves that engage with the splines 126.

As described further below, a second end 124 of the nut 108 can beconfigured to engage with a stem of a hip prosthesis or implant. In anexample, the nut 108 can include at least one cut-out or recessed trackfeature 129 at or near the second end 124, such as can be used to secureor lock the nut 108 on the stem of the prosthesis. In the example shownin FIGS. 3 and 4, the nut 108 includes three features 129 on the secondend 124. The features 129 can receive or otherwise interact withcorresponding respective protruding features on the stem, such as tosecure or lock the nut 108 on the stem of the prosthesis.

The screw 106 can be configured to secure the collar 104 to a proximalfemoral component of a hip prosthesis, such as shown in FIG. 5, and caninclude external threads 130 that can engage with corresponding internalthreads 132 on an inner surface 134 of the nut 108. The screw 106 canhave internal threading and the nut 108 can have external threading. Theattachment device 100 can optionally include a ring 136, such as havinga groove 137, which can be sized, shaped or otherwise configured toattach to the collar 104, for example, by a snap-fit, bonding, or otherattachment technique. The ring 136 can attach to the collar 104 suchthat the ring 136 can extend circumferentially around at least a portionof the collar 104. As shown in FIGS. 3 and 4, the screw 106 can includea groove 138, such as extending partly or completely around acircumference of the screw 106. The grooves 137 and 138 can be used toreceive a wire or cable, such as discussed below. In an example in whichthe trochanter attachment device does not include a ring, the collar caninclude an at least partially circumferential groove, and such groovecan be used to receive a wire, cable, or other reinforcing material.

In an example of the attachment device 100 shown in FIGS. 3 and 4, theplate 102 and the collar 104 can together be a singular piece and formedof the same material. Otherwise, the plate 102 and the collar 104 can beseparate pieces, such as can be bonded together, or attached by anothertechnique; in that case, the plate 102 and the collar 104 can be formedfrom the same material or of different materials.

In an example, the plate 102 and/or the collar 104 can include or can beformed of a porous structure, such as to facilitate bone ingrowth orregrowth. A porous biomaterial can be useful as a bone substitute, andcan have a porosity as low as 55%, 65%, or 75%, or as high as 80%, 85%,or 90%, or within any range defined by any of the foregoing values. Inan example, the porous structure can include or can be formed of amaterial produced using Trabecular Metal™ technology, generallyavailable from Zimmer, Inc. of Warsaw, Ind. Trabecular Metal™ is atrademark of Zimmer, Inc. Such a material can be formed using a foamedpolymer (such as polyurethane, as one example) that can be reduced to areticulated vitreous carbon foam substrate or skeleton. The carbonskeleton can be infiltrated and coated with a first layer ofbiocompatible metal, such as tantalum, to produce a low densitymaterial, and then plated with a second layer of tantalum to produce ahigh density material. The metal can be deposited on the carbonsubstrate by a chemical vapor deposition (CVD) process, such as in themanner disclosed in detail in U.S. Pat. No. 5,282,861, the disclosure ofwhich is incorporated herein by reference. One or more other metals,e.g., in addition to tantalum, including alloys thereof, can be used,such as, for example, niobium.

Generally, the porous structure can include a large plurality ofligaments defining open spaces there between, with each ligamentgenerally including a carbon core covered by a thin film of metal, suchas tantalum, for example. The open spaces between the ligaments can forma matrix of continuous channels, such as having no dead ends, such as topermit uninhibited growth of cancellous bone through the porous tantalumstructure. The porous structure can include up to 75%-85% or more voidspace therein. In an example, a porous tantalum structure can provide alightweight, strong porous structure that can be substantially uniformand consistent in composition, and that can closely resemble thestructure of natural cancellous bone, which can thereby provide a matrixinto which cancellous bone can grow. The porous tantalum structure canbe made in a density selected from a variety of densities, such as toselectively tailor the structure for a particular application. Theporous tantalum can be fabricated to permit selecting virtually anydesired porosity and pore size, and can thus be matched with thesurrounding natural bone, such as to provide an improved matrix for boneingrowth and mineralization.

The plate 102 or the collar 104 can be formed of other porous ornon-porous materials. For example, the plate 102 or the collar 104 canbe formed of stainless steel, cobalt, cobalt-chromium, titanium,tantalum, or one or more alloys thereof. As described above, the plate102 or the collar 104 can be formed of the same or different materials.All or a portion of the outer surface 114 of the plate 102 can be aporous tantalum structure, since the outer surface 114 will contact thegreater trochanter, and one or more other parts of the plate 102 can bea non-porous material. The plate 102 can be formed of a non-porousmaterial and all or part of the outer surface 114 of the plate 102 canbe coated with a porous structure, such as the porous tantalum structuredescribed above. Use of a porous material on the outer surface 114 ofthe plate 102 can promote fixation of the plate 102 to the greatertrochanter and/or can promote bone ingrowth.

The ring 136 can be made of a different material than the collar 104.The ring 136 can be made of a harder or more resistant material than thecollar 104, such as to protect the collar 104 if a reinforcing materialis used around the collar 104. In an example, the ring 136 can betitanium or a titanium alloy.

The screw 106 or the nut 108 can be made of one or more materials suchas can be used in fasteners for devices implanted inside a human oranimal body. These materials can include stainless steel, titanium,cobalt, or one or more alloys thereof. In an example, the screw 106 canbe made of titanium. In an example, the nut 108 can be made of stainlesssteel, titanium, cobalt, or one or more alloys thereof.

FIG. 5 shows an example of the trochanter attachment device 100 of FIGS.3 and 4 attached to a hip prosthesis or hip implant 150, which can besimilar to the prosthesis 50 shown in FIG. 2. As shown in FIG. 5, thetrochanter attachment device 100 can attach to a femoral component ofthe prosthesis or implant 150, which can include a body 156 and a stem158. The body 156 can include a neck portion 160 and an elongate portion162. The neck portion 160 can be sized shaped, or otherwise configuredto attach to a femoral head that is part of the complete prosthesisimplanted in a body.

As shown in FIG. 5, the trochanter attachment device 100 can attach tothe neck portion 160 of the body 156. The second end 120 of the collar104 can contact an outer surface of a top portion 164 of the body 156,which is a top surface of the femoral component of the hip implant 150.The inner surface 112 of the plate 102 can contact an outer surface on abackside 166 of the body 156. The inner surface 112 of the plate 102 maynot be centered on the backside 166 of the body 156; rather, the innersurface 112 can be located generally more on one side of the body 156than the other side. After attachment of the device 100 to the body 156,the plate 102 can have some movement or flexibility relative to the body156. As shown in FIG. 5, when the collar 104 is attached or secured tothe top surface 164 of the hip implant 150, an upper portion 168 of theplate 102 can extend above the top surface 164 and a lower portion 170of the plate 102 can extend below the top surface 164.

One or more like or different mechanisms can be employed to reinforceattachment of the greater trochanter 16 to the implant 150 and the femur10, such as once the implant 150 and the attachment device 100 areimplanted at least partially into the femur. Examples of possiblereinforcement mechanisms can include, but are not limited to, one ormore of a cable, a wire, a tiedown, a bolt, a suture, anotherreinforcement mechanism, or one or more combinations thereof. In anexample, the attachment device 100 can be sized, shaped, or otherwiseconfigured for receiving one or more wires; for example, a wire(s) canbe received in the groove 137 of the ring 136 and/or in the groove 138on the screw 106. Such wire(s) can be wrapped around the greatertrochanter 16 and/or the femur 10.

FIG. 6 is a cross-section of a portion of FIG. 5, showing an example ofthe attachment device 100 and the hip prosthesis 150. FIG. 6 shows thenut 108 extending through the neck portion 160 of the prosthesis 150. Inan example, the threads 132 on the inner surface 134 of the nut 108 canbe configured to engage with corresponding threads 157 on an outersurface 159 of the stem 158 of the prosthesis 150. The nut 108 can besecured on the stem 158, such as using the one or more track features129, which can be used to lock the nut 108 on the stem 158. Theattachment device 100 can be attached to a greater trochanter 16, suchas using the one or more apertures 110 on the plate 102, through which afastener can be inserted, such as to extend through the greatertrochanter 16 and the plate 102, at a location on the trochanter 16aligned with a particular one of the apertures 110.

Some approaches to designs of a proximal femoral component of a hipprosthesis can include a nut that is used to attach a stem to a bodyportion of the prosthesis. Thus, the attachment device 100 can includeor use a nut already used in the prosthesis. The nut from the hipprosthesis can optionally be modified for use in or with the attachmentdevice 100. In an example, such as shown in FIG. 6, a majority of alength of the inner surface 134 of the nut 108 can be threaded. Thelength of the nut 108 can include more or less threading, as compared tothe example shown in FIG. 6, and the specific threading can depend on adesign of the screw 106 and/or the stem 158.

In contrast to the prosthesis design shown in FIGS. 5 and 6, hipimplants can include a one-piece prosthesis that can include a neck andan elongate body portion. In those designs, an inner surface of theelongate portion 162 can include threads that can be configured toengage with corresponding threads on the nut 108.

As shown in FIGS. 5 and 6, in an example, the outer surface 114 of theplate 102 can have a curved or non-linear shape, such as can be used topromote fitting or fixation of the plate 102 to the greater trochanter16. In an example, the outer surface 114 of the plate 102 can begenerally straight or linear. As part of the preparation for attachmentof the trochanter attachment device 100 to a greater trochanter 16, areamer or other surgical device can be used to shape an inner surface ofthe greater trochanter 16, such as to accommodate the shape of the plate102, such as for improved or optimal fitting or fixation of the plate102 to the greater trochanter 16. In an example, a patient-specifictrochanter attachment device 100 can be used, in which case, the outersurface 114 or other feature of a plate 102 of the trochanter attachmentdevice 100 can be shaped to match a particular shape and/or dimension(s)of that particular patient's greater trochanter 16.

Although a screw 106 is shown in the example of the trochanterattachment device 100 shown in FIGS. 3-6, one or more other types offasteners can be used to secure the collar 104 of the device 100 to anouter surface of the neck portion 160 of the prosthesis 150 and tosecure the device 100 to the stem 158 of the prosthesis 150. In anexample, the attachment device 100 of FIGS. 3-6 can use a combination ofa screw 106 and a nut 108; however, a screw can be used without a nutand the screw can thread directly onto or into a stem of the implant.

FIG. 7 shows an example of a trochanter attachment device 200, similarto the attachment device 100, and which can include a plate 202, acollar 204, a screw 206, and a nut 208. Each of these components is alsoshown in FIG. 8, which is an exploded view of the trochanter attachmentdevice 200 of FIG. 7.

The attachment device 200 can also include an insert 209, which can besized, shaped, or otherwise configured to attach to an outer surface 214of the plate 202. The insert 209 can include one or more apertures 211,such as extending from an inner surface 213 to an outer surface 215 ofthe insert 209. The apertures 211 on the insert 209 can be arranged orotherwise configured to align with the apertures 210 on the plate 202.As similarly described above for the attachment device 100, the device200 can be attached to a greater trochanter 16, such as using one ormore fasteners and the apertures 210 on the plate 202 and the apertures211 on the insert 209, an example of which is shown in FIG. 10. Theinsert 209 can be bonded or otherwise attached to the plate 202, or theinsert 209 can be separate from the attachment device 200 beforeattachment to a greater trochanter 16. The plate 202 and the insert 209can include more or less than the two apertures shown in FIG. 10 on eachof the plate 202 and the insert 209.

The insert 209 can be used for fixation of the plate 202 to the greatertrochanter 16 and/or to promote integration of the plate 202 with thebone making up the greater trochanter 16. The insert 209 can include orcan be made of a porous material, such as a porous tantalum structure,such as can be made using the Trabecular Metal™ technology describedabove. The use of a porous material for the insert 209 can help promoteingrowth of the cancellous bone with the insert 209 and/or the plate202. The insert 209 can be sized, shaped, or otherwise configured suchthat it matches with a shape of the greater trochanter 16 or a desiredportion thereof. In an example, multiple inserts 209, such as of varioussizes and shapes, can be made available in a kit or otherwise for usewith the trochanter attachment device 200, and the user can select aparticular insert 209 to be used, such as based on a particular size andshape of the greater trochanter 16 for a particular patient. In anexample, a patient-specific insert 209 can be prepared for a specificpatient, prior to surgery, such as based on a predetermined size andshape of the patient's greater trochanter 16, such as can be ascertainedusing a medical imaging modality or other technique. As an alternativeto or in addition to a patient-specific insert 209, a patient-specificplate 202 can similarly be prepared for a patient.

As visible in FIG. 8, the collar 204 can include a groove 205, such ascan be sized, shaped, or otherwise configured for receiving a wire,cable, or other reinforcing material. The groove 205 can be larger orsmaller than that shown in FIG. 8. The collar 204 can include anaperture 207, such as for receiving a screw or other similar or suitablefastener, such as to prevent or limit movement of the screw 206. Asimilar aperture can be included elsewhere, such as on the other side ofthe collar 204, which is not visible in FIGS. 7 and 8.

As shown in FIG. 7, the plate 202 can include one or more apertures 203,such as for use as suture wire holes. The apertures 203 can be used tohelp anchor the greater trochanter 16 to the implant or prosthesis.Similar apertures can be included on the plate 102 of the attachmentdevice 100. The trochanter attachment devices 100 and 200 can includeany one or more of a variety of features, in addition to or as analternative to those described herein, such as for receiving a cable, awire, or another reinforcing mechanism, such as to reinforce attachmentof the device 100 or 200 to the greater trochanter 16 and/or to femoralcomponent of the hip implant.

Similar to a design of the nut 108 of the trochanter attachment device100, the nut 208 of the trochanter attachment device 200 can includesplines 226 near a first end 222 of the nut 208. The splines 226 can bewell-suited if an inside portion of the collar 204 is formed of a porousmaterial, such that the splines 226 can grip an inside of the collar204. In an example, the nut 208 can be configured without any splines.Other known features and methods can be used to attach or fit the nut208 to the collar 204.

FIG. 9 shows an example of the trochanter attachment device 200 attachedto a greater trochanter 180, which can be similar to the greatertrochanter 16 of FIG. 1. As also shown in FIG. 9, the device 200 canalso be implanted in a canal of the femur 182 and attached to a femoralcomponent of a hip prosthesis 250, which can be similar to prosthesis150 of FIGS. 5 and 6. Fasteners 190 and 192 can extend through thegreater trochanter 180, such as to attach the device 200 to the greatertrochanter 180, such as also shown in FIG. 10. As visible in FIG. 9, inan example, a second end 220 of the collar 204 can be curved or slopeddownward from a front side 219 to a back side 221 of the collar 204. Assuch, the collar 204 can be configured to engage with a prosthesishaving a more angled neck portion compared to the prosthesis shown inFIG. 9. The collar 204 can have more or less of a sloped (or curved)design, if any, from the front 219 to back side 221.

FIG. 10 is a cross-sectional view of what is shown in FIG. 9. Fasteners190 and 192 can extend through the plate 202 and the insert 209, such asvia apertures 210 and 211, respectively, such as to attach the device200 to the greater trochanter 180. The fasteners 190 and 192 can bedrilled or otherwise passed through an outer surface of the greatertrochanter 180. The apertures 210 and 211 of the plate 202 and theinsert 209 can be preformed with the trochanter attachment device 200.The fasteners 190 and 192, as shown in FIGS. 9 and 10, can be orientedgenerally perpendicular to the plate 202 and the insert 209; similarly,the apertures 210 and 211 can be oriented generally perpendicularrelative to a length of the plate 202 and the insert 209, respectively.In an example, the apertures 210 and 211 can be oriented at an anglerelative to the length of the plate 202 and the insert 209, in whichcase, the fasteners 190 and 192 can be inserted at a correspondingangle.

In an example, the apertures 210 and 211 can be formed as part of theprocedure for using the trochanter attachment device 200 to secure thegreater trochanter 180 to the femur 182. The user can determine aparticular placement and angle of the apertures 210 and 211, which candepend, at least in part, on the particular patient's anatomy and theshape and condition of the patient's greater trochanter.

As shown in FIG. 10 and similarly described above in reference to FIG.6, the nut 208 of the attachment device 200 can be threaded, such as toengage with both the screw 206 and a stem 258 of the prosthesis 250,each of which can have a threaded outer surface. As also described abovein reference to device 200, the nut 208 can include more or lessthreading. Before or during the procedure to attach the device 200 tothe greater trochanter 180, an inner surface of the greater trochanter180 can be shaped, such as to better engage with the insert 209 and/orthe plate 202.

FIG. 11 shows an example of a trochanter attachment device 300 similarto the trochanter attachment devices 100 and 200. The trochanterattachment device 300 can include a plate 302, a collar 304, a screw306, and a nut 308. The trochanter attachment device 300 can include aninterference fit between the nut 308 and the collar 304. Suchinterference fit can include, for example, a taper lock created by thenut 308 and the screw 306. A taper lock can commonly be used for modularconnections. The nut 308 can include a cone-shaped portion 323 at ornear a first end 322 of the nut 308 and configured to engage with aninside surface of the collar 304. The cone-shaped portion 323 can beshaped or otherwise configured such that the screw 306 can lock the nut308 into place inside the collar 304. A diameter of the nut 308 at afirst end 325 of the cone-shaped portion 323 can be less than a diameterof the nut 308 at a second end 327 of the cone-shaped portion 323. (Thefirst end 325 of the cone-shaped portion 323 can generally coincide withthe first end 322 of the nut 308.)

As shown in FIG. 11, in an example, the trochanter attachment device 300can be configured to not include a ring for attachment to the collar 304and/or not include an insert for attachment to the plate 302. In anexample, the trochanter attachment device 300 can include a ring, likethe ring 136 of the trochanter attachment device 100, and/or an insert,like the insert 209 of the trochanter attachment device 200.

The present disclosure includes a method of securing a greatertrochanter to the femur, such as using a trochanter attachment device,such as described herein. The method can include attaching a plate ofthe trochanter attachment device to an inner surface of a greatertrochanter, and attaching a collar of the trochanter attachment deviceto a hip implant implantable in the femur. More specifically, thetrochanter attachment device can be attached to the proximal femoralcomponent of a hip implant. The trochanter attachment device can beattached to the hip implant after the hip implant is installed in thediaphysis of the femoral bone. The trochanter attachment device can beattached to the greater trochanter before or after the trochanterattachment device is attached to the hip implant. The method of securingthe greater trochanter to the femur can include using at least onereinforcing material or mechanism or device, such as described above,such as to secure the trochanter attachment device to the greatertrochanter and the hip implant. Examples of such a reinforcing material,mechanism, or device can include a cable, a wire, a bolt, a suture, orone or more combinations thereof. As described above, the trochanterattachment device can include one or more features that can be sized,shaped, or otherwise configured for receiving or engaging with thereinforcing material, mechanism, or device.

Although specific configurations of a trochanter attachment device areshown in FIGS. 3-11 and particularly described above, other designs of atrochanter attachment device can be used. The trochanter attachmentdevice described herein can be easily configurable, such as forattachment to any of a variety of types of hip implants, including bothmodular designs, having a detachable stem, and one-piece designs. Thetrochanter attachment device can also be customized (e.g., provided withat least one patient specific component) such as through the use, forexample, of a customizable insert piece, which can be sized, shaped, orotherwise configured to be placed between the plate and the greatertrochanter.

In the examples shown in FIGS. 3-11, a screw and a nut can be included,such as for attaching the collar of the trochanter attachment device tothe body of the implant, and/or for attaching the device to the stem ofthe implant. It is recognized that additional or alternativeconfigurations can be used to secure the attachment device to theimplant. For example, depending on a length of the screw, a screw of theattachment device can directly attach to the stem of the implant, and assuch, a nut may optionally be omitted.

The trochanter attachment device is particularly described herein foruse in reattaching the greater trochanter to the femur or reinforcingthe existing attachment, or partial attachment, of the greatertrochanter to the femur. The trochanter attachment device describedherein can also be used in other situations, such as in which thegreater trochanter is completely compromised and no longer available forattachment to the femur. In those cases, the plate of the attachmentdevice can be attached to surrounding soft tissue, such as, for example,ligaments and muscles, including the abductor. Particularly if the plateis made of, or coated or otherwise provided with, a porous structure,the attachment device can facilitate soft tissue ingrowth and betterstabilize the femoral component of the hip implant to which theattachment device is attached. An attachment device with the insertshown in FIGS. 7-10 can be used to facilitate soft tissue ingrowth,particularly if the insert is made of, or coated or otherwise providedwith, a porous structure. An insert made of a porous structure can beused as an alternative to, or in addition to, a plate made of a porousstructure.

The above detailed description includes references to the accompanyingdrawings, which form a part of the detailed description. The drawingsshow, by way of illustration, specific embodiments in which theinvention can be practiced. These embodiments are also referred toherein as “examples.” Such examples can include elements in addition tothose shown or described. However, the present inventors alsocontemplate examples in which only those elements shown or described areprovided. Moreover, the present inventors also contemplate examplesusing any combination or permutation of those elements shown ordescribed (or one or more aspects thereof), either with respect to aparticular example (or one or more aspects thereof), or with respect toother examples (or one or more aspects thereof) shown or describedherein.

In the event of inconsistent usages between this document and anydocuments so incorporated by reference, the usage in this documentcontrols. In this document, the terms “a” or “an” are used, as is commonin patent documents, to include one or more than one, independent of anyother instances or usages of “at least one” or “one or more.” In thisdocument, the term “or” is used to refer to a nonexclusive or, such that“A or B” includes “A but not B,” “B but not A,” and “A and B,” unlessotherwise indicated. In this document, the terms “including” and “inwhich” are used as the plain-English equivalents of the respective terms“comprising” and “wherein.” Also, in the following claims, the terms“including” and “comprising” are open-ended, that is, a system, device,article, composition, formulation, or process that includes elements inaddition to those listed after such a term in a claim are still deemedto fall within the scope of that claim. Moreover, in the followingclaims, the terms “first,” “second,” and “third,” etc. are used merelyas labels, and are not intended to impose numerical requirements ontheir objects.

The above description is intended to be illustrative, and notrestrictive. For example, the above-described examples (or one or moreaspects thereof) may be used in combination with each other. Otherembodiments can be used, such as by one of ordinary skill in the artupon reviewing the above description. The Abstract is provided to complywith 37 C.F.R. §1.72(b), to allow the reader to quickly ascertain thenature of the technical disclosure. It is submitted with theunderstanding that it will not be used to interpret or limit the scopeor meaning of the claims. Also, in the above Detailed Description,various features may be grouped together to streamline the disclosure.This should not be interpreted as intending that an unclaimed disclosedfeature is essential to any claim. Rather, inventive subject matter maylie in less than all features of a particular disclosed embodiment.Thus, the following claims are hereby incorporated into the DetailedDescription as examples or embodiments, with each claim standing on itsown as a separate embodiment, and it is contemplated that suchembodiments can be combined with each other in various combinations orpermutations. The scope of the invention should be determined withreference to the appended claims, along with the full scope ofequivalents to which such claims are entitled.

1. (canceled)
 2. A trochanter attachment device comprising: a platehaving an inner surface and an outer surface, the outer surfaceconfigured to attach to an inner portion of a greater trochanter of afemur; and a collar connected to the inner surface of the plate andhaving an aperture configured to receive a collar fastener to attach thetrochanter attachment device to a hip implant.
 3. The trochanterattachment device of claim 2, wherein the plate includes an aperture forreceiving a plate fastener to attach the plate to the greatertrochanter.
 4. The trochanter attachment device of claim 2, wherein thecollar is oriented generally perpendicular to the plate such that, whenthe collar fastener is received through the aperture in the collar, thecollar fastener and the plate extend in a direction generally parallelto each other.
 5. The trochanter attachment device of claim 2, whereinthe collar fastener comprises a screw and a nut, and wherein the nut isconfigured to engage with the screw and a stem of the hip implant. 6.The trochanter attachment device of claim 5, wherein the nut comprises:a first end portion, having a threaded portion configured to engage withthe screw; and a second end portion, having a threaded portionconfigured to engage with the stem of the hip implant.
 7. The trochanterattachment device of claim 5, wherein the nut comprises a spline on anouter surface of the nut, and wherein the spline is configured to engagewith an inside surface of the collar.
 8. The trochanter attachmentdevice of claim 5, wherein a first end portion of the nut includes acone-shaped portion configured to engage with an inside surface of thecollar.
 9. The trochanter attachment device of claim 2, wherein when thetrochanter attachment device is attached to the hip implant, a bottomend of the collar is configured to contact a top surface of the hipimplant, an upper portion of the plate is configured to extend above thetop surface of the hip implant, and a lower portion of the plate isconfigured to extend below the top surface of the hip implant.
 10. Thetrochanter attachment device of claim 2, further comprising: an insert,configured to be attachable to the outer surface of the plate, andconfigured to attach the plate to the greater trochanter, and the insertincludes a porous portion.
 11. A trochanter attachment devicecomprising: a plate having an inner surface and an outer surface, theouter surface configured to attach to an inner portion of a greatertrochanter of a femur, the plate having one or more apertures forreceiving one or more plate fasteners to attach the plate to the greatertrochanter; and a collar connected to the inner surface of the plate andconfigured to contact an outer surface of a hip implant, the collarhaving an aperture configured to receive a collar fastener to attach thetrochanter attachment device to the hip implant.
 12. The trochanterattachment device of claim 11, wherein the collar fastener comprises: ascrew, configured to extend through the collar for securing the collarto the hip implant; and a nut, having a first end portion and a secondend portion, wherein the first end portion is configured to engage withthe collar and the screw, and the second end portion is configured toengage with a stem portion of the hip implant.
 13. The trochanterattachment device of claim 11, further comprising a ring including agroove extending at least partially circumferentially around an outersurface of the ring, wherein the ring is configured to be attachable toan outer surface of the collar.
 14. The trochanter attachment device ofclaim 11, the collar includes a groove on an outer surface of thecollar, configured for receiving a reinforcing material.
 15. Thetrochanter attachment device of claim 11, wherein the plate and thecollar include a porous tantalum region.
 16. A method of securing agreater trochanter to a femur using an attachment device, the methodcomprising: implanting a hip implant in a diaphysis of the femur;attaching the attachment device to an inner portion of the greatertrochanter; and attaching the attachment device to the hip implant. 17.The method of claim 16, wherein the attachment device includes a plateand attaching the attachment device to an inner portion of the greatertrochanter includes attaching an outer surface of the plate to the innerportion of the greater trochanter.
 18. The method of claim 16, whereinattaching the outer surface of the plate to an inner portion of thegreater trochanter includes inserting a fastener into an aperture formedin the greater trochanter and through an aperture in the plate.
 19. Themethod of claim 16, wherein attaching the outer surface of the plate toan inner portion of the greater trochanter includes placing an insertbetween the plate and the inner surface of the greater trochanter, andwherein the insert includes a porous material.
 20. The method of claim16, wherein the attachment device includes a collar and attaching theattachment device to the hip implant includes attaching the collar to atop surface of the implant by inserting a fastener through an aperturein the collar.
 21. The method of claim 16 further comprising:reinforcing attachment of the attachment device to at least one of thegreater trochanter and the hip implant using at least one reinforcingmaterial.
 22. The method of claim 21, wherein the at least onereinforcing material includes at least one of a cable, a wire, a bolt, asuture, or one or more combinations thereof, and the attachment deviceincludes at least one feature configured to receive the at least onereinforcing material.